Impact of the Nutri-Score front-of-pack nutrition label on purchasing intentions of individuals with chronic diseases: results of a randomised trial

Manon Egnell, Isabelle Boutron, Sandrine Péneau, Pauline Ducrot, Mathilde Touvier, Pilar Galan, Léopold Fezeu, Raphaël Porcher, Philippe Ravaud, Serge Hercberg, Emmanuelle Kesse-Guyot, Chantal Julia, Manon Egnell, Isabelle Boutron, Sandrine Péneau, Pauline Ducrot, Mathilde Touvier, Pilar Galan, Léopold Fezeu, Raphaël Porcher, Philippe Ravaud, Serge Hercberg, Emmanuelle Kesse-Guyot, Chantal Julia

Abstract

Objective: To our knowledge, the effect of front-of-pack nutrition labels such as the Nutri-Score on food purchases has never been assessed among individuals suffering from nutrition-related chronic diseases specifically, while dietary modifications are generally part of their care. This study aimed to investigate the effect of the Nutri-Score on the nutritional quality of purchasing intentions among adults suffering from a cardiometabolic disease, compared with no label and the Reference Intakes (RIs), a label already implemented by some food manufacturers in France.

Setting: Secondary prevention-mainland France.

Participants: 2431 eligible participants were randomly assigned and 1180 participants (65.5% women, mean age 65.0±7.1 years) completed the shopping task and were included in the analyses.

Intervention: A three-arm randomised controlled trial using an experimental online supermarket was conducted in 2017. Participants with cardiometabolic diseases were invited to simulate food purchases with the Nutri-Score, the RIs or no label.

Primary and secondary outcome measures: The primary outcome was the nutritional quality of the shopping cart, estimated using the French-modified Food Standard Agency Nutrient Profiling System (FSAm-NPS), and secondary outcomes included the nutrient content of purchases.

Results: The mean (SD) FSAm-NPS score was significantly lower in the Nutri-Score arm (1.29 (3.61) points), reflecting a higher overall nutritional quality of purchasing intentions, compared with the RIs (1.86 (3.23) points) and no label (1.92 (2.90) points) arms (p=0.01). Moreover, the Nutri-Score led to significantly lower content in calories and saturated fatty acids compared with the two other arms. These differences resulted from participants avoiding some packaged products (sweets, dairy and starches) and purchasing larger amounts of fresh fruit and meat.

Conclusions: The Nutri-Score exhibited a significant higher nutritional quality of purchasing intentions, encouraging healthier food choices among individuals suffering from cardiometabolic chronic diseases.

Trial registration number: NCT02769455.

Keywords: epidemiology; health policy; nutrition & dietetics.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
An example of a food product in the Nutri-Score (1), Reference Intakes (2) and no label (3) arms. Images developed by the coauthors.
Figure 2
Figure 2
Flow diagram of the randomised controlled trial. *Subjects who validated their online shopping cart and did not encounter technical issues. RI, Reference Intakes.

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